Exploring Predictors of Ketamine Response in Adolescent Treatment-Resistant Depression
Alice Lineham, Victor J. Avila‐quintero, Michael H. Bloch, Jennifer B. Dwyer
Journal of Child and Adolescent Psychopharmacology January 3, 2024 DOI: 10.1089/cap.2023.0047 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Population | Adolescents with treatment-resistant depression |
| Interventions | Ketamine Midazolam |
| Duration | Single-dose, assessed at 1 and 7 days postinfusion |
| Topics | Anxiety Depression Ketamine Esketamine |
| Keywords | Depression economics Antidepressant Rating scale Randomized controlled trial Serotonin reuptake inhibitor Clinical trial Clinical psychology Cognition |
| Citations | 15 |
| Registration | NCT02579928 |
| Key findings | Fewer prior medication trials, shorter current depressive episode, and current selective serotonin reuptake inhibitor use predicted greater depression symptom improvement with ketamine in adolescents. |
Abstract
Objective:Ketamine has proved effective as a rapid-acting antidepressant agent, but treatment is not effective for everyone (approximately a quarter to a half of patients). Some adult studies have begun to investigate predictors of ketamine's antidepressant response, but no studies have examined this in adolescents with depression. Methods:We conducted a secondary data analysis of adolescents who participated in a randomized, single-dose, midazolam-controlled crossover trial of ketamine for adolescents with treatment-resistant depression. We examined the relationship between 19 exploratory demographic and clinical variables and depression symptom improvement (using the Montgomery-Åsberg Depression Rating Scale [MADRS]) at 1 and 7 days postinfusion. Results:Subjects who had fewer medication trials of both antidepressant medications and augmentation treatments were more likely to experience depression symptom improvement with ketamine. Subjects with shorter duration of their current depressive episode were more likely to experience depression symptom improvement with ketamine. Subjects currently being treated with selective serotonin reuptake inhibitor medications, and not being treated with serotonin–norepinephrine reuptake inhibitor medications, also experienced greater symptom improvement with ketamine. When receiving the midazolam control, less severe depressive symptoms, as measured by the Children's Depression Rating Scale (CDRS) (but not MADRS), and a comorbid attention-deficit/hyperactivity disorder diagnosis were associated with increased response. Conclusions:Findings should be viewed as preliminary and exploratory given the small sample size and multiple secondary analyses. Identifying meaningful predictors of ketamine response is important to inform future therapeutic use of this compound, however, considerably more research is warranted before such clinical guidance is established. The trial was registered in clinicaltrials.gov with the identifier NCT02579928.
Comparable studies
Other randomized controlled trials on ketamine for anxiety, most cited first.